Uveitis in Adults: A Review

Area of Science:

• Ophthalmology
• Immunology
• Rheumatology

Background:

• Uveitis involves inflammation of the eye's uvea, affecting vision and potentially causing severe complications like glaucoma and blindness.
• It predominantly impacts adults aged 20-50 and can be classified by anatomical location (anterior, intermediate, posterior, panuveitis) and etiology (infectious or noninfectious).
• Noninfectious uveitis is often associated with systemic conditions like axial spondyloarthritis, while infectious causes include toxoplasmosis, herpes, tuberculosis, and HIV.

Purpose of the Study:

• To summarize the current understanding of uveitis, including its classification, risk factors, and treatment strategies.
• To highlight the importance of timely and appropriate management to prevent vision-threatening complications.
• To review the efficacy of various therapeutic approaches for different uveitis subtypes.

Main Methods:

• Review of existing literature on uveitis epidemiology, pathogenesis, and clinical management.
• Analysis of treatment outcomes for different uveitis classifications, including infectious and noninfectious etiologies.
• Evaluation of first-line and second-line therapies, including corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologics.

Main Results:

• Anterior uveitis typically responds to topical corticosteroids.
• For posterior noninfectious uveitis, DMARDs like methotrexate and mycophenolate mofetil are effective first-line treatments, achieving remission in a significant percentage of patients.
• Biologics such as adalimumab demonstrate efficacy as second-line therapy for refractory cases, extending time to treatment failure compared to placebo.

Conclusions:

• Uveitis management requires a tailored approach based on subtype and etiology.
• Early intervention with appropriate therapies, including corticosteroids, DMARDs, and biologics, is crucial for preserving vision.
• Addressing underlying systemic conditions and minimizing corticosteroid side effects are key goals in uveitis treatment.